Dental health

Challenges to care abound in southeast Ohio

January 15, 2013

Access to oral health care in southeastern Ohio is falling short, especially when it comes to children, according to a recently-released state study.

At the Southeastern Ohio Dental Clinic in Marietta, many patients coming in are already experiencing painful problems in their baby teeth, said Karita Miller, the office manager at the clinic.

"We have had children in elementary school that have needed to have all of their baby teeth pulled," she said.

Article Photos

Dental hygienist Adessa Jackson performs an X-ray on 15-year-old Belpre resident Leha Bass at the Southeastern Ohio Dental Clinic Thursday. The clinic, one of the only dental facilities in the area that accepts Medicaid and allows payment based on income, recently lost a grant that covered a large portion of their funding.

JASMINE ROGERS The Marietta Times

A recent study by the Ohio Department of Health of third grade students found that 27 percent of Appalachian students in the state had untreated cavities compared to 17 percent of non-Appalachian Ohio third graders.

The challenges for rural Ohioans seeking dental care are many. For starters, Medicare does not cover dental services and few dentists accept Medicaid or offer income-based sliding payment scales.

According to the Ohio Department of Health's most recent survey, nine dentists in Washington County accepted Medicaid in 2009. That is one dentist per 1,374 Medicaid patients.

Fact Box

Oral health

statistics

Ohio third grade children who have a history of tooth decay:

- Appalachian: 58 percent

- Non-Appalachian: 50 percent

Ohio third grade children who have untreated cavities:

- Appalachian: 27 percent

- Non-Appalachian: 17 percent

Ohio third grade children who need early or urgent dental care:

- Appalachian: 27 percent

- Non-Appalachian: 18 percent

Ohioans ages 19-64 who have had all permanent teeth removed due to tooth decay or gum disease:

- Appalachian: 7 percent

- Metropolitan: 3 percent

- Rural/Non-Appalachian: 5 percent

- Suburban: 2 percent

- Statewide: 4 percent

Ohioans ages 19-64 who have had a dental visit in the past year:

- Appalachian: 61 percent

- Metropolitan: 73 percent

- Rural/Non-Appalachian: 69 percent

- Suburban: 76 percent

- Statewide: 71 percent

Ohioans ages 19-64 who have not visited the dentist for five or more years:

- Appalachian: 15 percent

- Metropolitan: 9 percent

- Rural/Non-Appalachian: 12 percent

- Suburban: 7 percent

- Statewide: 10 percent

Ohioans ages 65 and older who have had all permanent teeth removed due to tooth decay or gum disease:

- Appalachian: 26 percent

- Metropolitan: 20 percent

- Rural/Non-Appalachian: 19 percent

- Suburban: 17 percent

- Statewide: 20 percent

Ohioans ages 65 and older who have had a dental visit in the past year:

- Appalachian: 53 percent

-Metropolitan: 69 percent

-Rural/Non-Appalachian: 62 percent

-Suburban: 69 percent

-Statewide: 66 percent

Ohioans ages 65 and older who have not visited the dentist for five or more years:

-Appalachian: 29 percent

-Metropolitan: 16 percent

-Rural/Non-Appalachian: 20 percent

-Suburban: 14 percent

-Statewide: 18 percent

In Morgan County, the number of dentists accepting Medicaid dropped to two, in Noble County it was one and in Monroe County there were none at the time of the survey.

The Southeastern Ohio Dental Clinic, which has been operated by the Washington County Health Department since 2006, does accept Medicaid and is the only dentist office in the area that allows income eligible patients to pay only a percentage of their dentistry fees, said Miller.

Belpre resident Leha Bass, 15, started coming to the clinic after her former dentist stopped accepting her insurance company, said her mother, Laura Postle-Morrison.

"We couldn't find another dentist that accepted her insurance until we found here, and we started getting her back into her check-ups," she said.

Dental care has always been a concern for Postle-Morrison, who wants to ensure that her daughter's teeth stay healthy.

Bass was in the office last week to follow up on a recent filling performed there. However, when she had to have a root canal, Bass was forced to go all the way to Columbus to find a doctor who would perform the surgery and accept her insurance.

"There are dentists that could have done it here, but they won't take her insurance," said Postle-Morrison.

The Marietta clinic is one of the last local options for many people. However, the health department found out earlier this month that the $59,000 grant that helps fund the site was not renewed for the 2013 year.

"We don't know why the grant wasn't approved. What we've heard is that the funding got cut on a federal level," said Ken Robinson, interim administrator of the health department.

About 30 patients are scheduled at the clinic every day,

"We get a lot of no-shows though," said Miller.

The reason patients skip appointments ranges from lack of transportation to lack of education about oral care, both problems that may occur more in Appalachia.

Many patients, including parents, neglect preventative care, such as twice yearly cleanings and check-ups, said Miller. Therefore, many of the clinic's patients are experiencing significant pain by the time they seek treatment.

"It is very rare for (the dentist) to do a cleaning and the patient not need anything done," said Miller.

The clinic covers procedures such as cleanings, fillings, and simple extractions, but they do not provide services that require general anesthesia.

Patients that need more serious work done are referred to income-based oral surgeons.

Often, young patients with a multitude of problems are referred to a pediatric dentist in Columbus, said Miller.

However, all too often Miller runs into the frustrating problem of resistant parents.

"Parents don't get it sometimes. They think it's just their baby teeth, so why does it matter," said Miller.

But baby teeth are the guides for a child's adult teeth, and unhealthy baby teeth can quickly lead to complications, she added.

To try to overcome the many obstacles facing young Appalachians, a number of programs aim to provide oral care and education in the schools, said Eric Tolkin, chief marking officer for Smile Programs...The Mobile Dentists.

"Rather than waiting for the need to come to the care, we bring the care to the need," he said.

The Mobile Dentists program services 14 states, including Ohio and West Virginia. The program employ dentists licensed in Ohio to go into Ohio schools and provide X-rays, cleanings and dental sealants to children who would otherwise go without care. Sealants, as the name suggests, are protective caps that are placed on teeth to prevent decay, said Tolkin.

A similar sealant program is run by the Washington County Health Department, said Renee Robinson, who coordinates the program.

Like The Mobile Dentists, Washington County's in-school sealant program is free of charge. It is targeted at second and sixth grade students, both of whom are at important stages of dental development, said Robinson.

On top of these programs that provide oral check-ups and care, schools are trying to offer more education to students about the importance of dental hygiene. For the past nine years, Ginnie Powers, treatment and marketing coordinator for Eckels Orthodontics, has been donning a set of glittery wings and teaching students about the importance of oral care.

As the tooth fairy, Powers has talked to second and third grade students in approximately 40 schools, alleviating fears children might have about the dentist and stressing essential habits.

"It was pretty successful right off the bat. Some of the kids I'll see a year or two later and the will come running up and say that they still use their toothbrush timer and they do brush every day," she said.

Additionally, Orthodontist Scott Eckels founded a local chapter of Smile For A Lifetime, a nonprofit foundation aimed at providing orthodontic care for children in low-income families.

Eckels covers the complete costs of orthodontics for 24 children a year, who are chosen based on need by a local board of directors, said Powers. Local dentists also pitch in to help with overall dentistry needs, such as fillings or crowns, for the patients, she added.

Orthodontics are an important part of overall oral health because properly aligned teeth help prevent wear on the enamel and inaccessible cavities, Powers said.

Despite a variety of educational and oral health programs in schools, the ODH study shows that oral health in Appalachia is not yet improving.

A 2004-2005 survey of third graders found that 27.9 percent of Washington County third graders had untreated dental decay compared to 25.7 percent of Ohio third graders overall. The most recent version of that survey, conducted over the 2009-2010 school year, found that while the percentage of Washington County third graders with untreated decay jumped to 35.6 percent, the actual overall Ohio percentage went down to 18.7 percent.

It's an uphill battle, and the sticking point, said Miller, is going to be getting parents educated on healthy habits and making sure they enforce those habits.

The local Head Start program does enforce preventative care for their preschool students, she added. Preschool students have to get a signed waiver saying they had a check-up before the school year begins. Similar to enforcing certain vaccinations before the school year, requiring yearly dental check-ups would be a good system to ensure better dental care, she said.

"It'd be good to see that put into place in elementary schools, too," said Miller.